The longitudinality of care from the perspective of Family Health users

Qualitative research carried out with 18 users of a family health unit in a municipality in the state of São Paulo. The data was produced through semi-structured interviews and the empirical material was analyzed by interpreting the meanings in the light of the theoretical framework of continuity of care and longitudinality.

Results:

22 ideas were identified and grouped into three meanings: organization and operationalization of work in the family health unit, self-care and the health system. The first highlighted elements of organizational constraints, workforce, hard and soft technologies. The second direction pointed to the user’s co-responsibility for their health condition and lifestyle, making it possible to recognize longitudinality as: discontinuous or focused and continuous or extended. And in the third meaning, the understanding of the functioning of the three levels of care was presented with structural and technological demarcations.

Conclusion:

The users recognized potential and weaknesses in the three meanings referring to the constituent elements of the theoretical framework. Family Health is capable of offering continuous or extended longitudinality, even in a municipality with low coverage of the strategy. However, this scenario can weaken the process of developing the attribute from this perspective, as it limits access to other levels of care and compromises its structuring elements and dimensions and, consequently, the continuity of care.

DESCRIPTORS
Primary Health Care; Continuity of Patient Care; Patients

Identification or recognition of the regular source of care
1. Does the unit have client enrollment? 2. Is the unit recognized by the assigned population as a place of care for old and new health problems?
Interpersonal relations
3. Is the patient seen regularly by the same doctor and/or nurse for routine appointments? 4. Do the professionals who see the patient know the patient’s family and social history? 5. If in doubt about treatment, can the patient speak to the professional who sees them regularly? 6. Is there enough time during treatment for patients to explain their doubts, complaints and concerns? 7. Are the patient’s doubts, concerns and complaints valued? Are they recorded in the medical records? 8. Does the professional express themselves clearly, in a way that the patient understands? 9. Is there room for the patient to discuss their treatment and make decisions together with the professional?
Informational continuity
10. Do health professionals use medical records when providing care? 11. Are health professionals informed about all the medicines used by the patient? 12. Are healthcare professionals informed about the tests carried out on the patient? 13. In the event of a referral to a specialist, does this professional receive recorded information from the unit that sees the patient on a regular basis? 14. In the case of referrals for specialist consultations or external examinations, are the results returned to the clinician who sees the patient on a regular basis? 15. Are health professionals informed when a patient is unable to obtain the prescribed medication?

Organization and operationalization of work at the FHU
1. Family Health Unit catchment area
2. Family Health Unit’s limited service’s capacity
3. Family Health Unit work process
4. CHW functions
5. Longitudinal care by the team
6. Work tools (Health records)
7. Professional turnover in the team
8. Priority of care at the Family Health Unit
9. Disease-centered approach to production of care
10. Expanded view of care production
11. Lack of closeness between professionals and users
12. Trust and bonds
13. Empathy and dialogue
14. Assertive communication
15. FHU quality of care
Organization and operationalization of self-care
16. Users’ co-responsibility for their health
17. Users’ knowledge about their care
Organization and operation of the health system
18. Referral and counter-referral
19. Limited service’s capacity at secondary level
20. Health system organization
21. State’s responsibility with regard to high-cost drugs
22. Limitations on the supply of essential medicines

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[1] Corresponding author: Anna Maria Meyer Maciel, Av. Juca Stockler, 1130, Bloco 1, Belo Horizonte, 37900-106 – Passos, MG, Brazil, anna.maciel@uemg.br